Benign paroxysmal positional vertigo (BPPV) is one of the leading causes of vertigo, a sensation of spinning or movement. Symptoms of BPPV are triggered by changes in the position of your head, and may occur suddenly, without warning.

What Causes BPPV?

Tiny calcium carbonate crystals are a normal part of the anatomy of the inner ear. Occasionally they dislodge from the otolithic membrane and collect in the semicircular canals, structures that contain fluid and tiny hair-like sensors that detect rotational movement. When the head is still, the crystals clump together and settle. But when the head moves, the crystals shift, causing the vestibular system to send false signals to the brain that result in dizziness.

In many cases, the specific cause of these crystals breaking loose is unknown. Trauma to the head can be a factor, as well as disorders of the inner ear, migraines, and side effects of ear surgery. Normal aging and degeneration of the otolithic membrane are responsible for cases in people over the age of 50.


The chief symptom of BPPV is vertigo. This may be accompanied by dizziness, lightheadedness, unsteadiness, a loss of balance, blurred vision, nausea, vomiting, and difficulty concentrating. Episodes are typically short in duration, lasting no longer than a minute, and can disappear for long periods before recurring.

Any unexplained dizziness or vertigo that persists for longer than a week is cause for concern, and warrants a visit to your doctor.


BPPV is most commonly treated with repositioning head maneuvers designed to move the displaced crystals out of the semicircular canals. This technique, known as the canalith repositioning procedure (or Epley maneuver), involves sequential movements of the head into four positions, held for about 30 seconds each. It can be performed by your doctor, audiologist, or a physical therapist, and is usually effective after one or two treatments.

In rare cases, canalith repositioning is ineffective. If the head maneuvers don’t work, options exist for vestibular rehabilitation exercises at home, canal plugging surgery, or medications.